Medication Therapy Management Program

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Medication Therapy Management: Review Your Medicine

What is the Medication Therapy Management Program?

Medication Therapy Management (MTM) is a Medicare-designed program that helps make sure that your medications are working to maintain your health. This service is provided at no additional cost to qualified members and is not considered a Medicare Part D benefit.

If you take multiple medicines prescribed by more than one doctor, these medicines may, when combined:

  • Reduce the effectiveness of one or more of your medicines
  • Cause severe side effects
  • Cost you more money per month

As part of our MTM program, you may set up a one-on-one review of your medicines with a pharmacist. This review is called a Comprehensive Medication Review (CMR) and is offered at no extra cost to you. However, once enrolled in the program, you may be contacted about a Targeted Medication Review (TMR), if a pharmacist identifies a potential medication issue that needs attention after completing the CMR.

By participating in the program we want to help you get the best results from all of the medications you’re taking. When you talk to a pharmacist he or she can help you make sure your medications are working for you, find lower cost options (when possible), and answer any questions or concerns you have about your medications.

How You Qualify for the Program

CarePlus determines eligibility monthly, by looking at your medication claims information. To qualify for the MTM program, you must meet all three of the following criteria:

  • Have three of the five following conditions:
    2019 Conditions: Chronic Heart Failure (CHF), Osteoporosis, Diabetes, Dyslipidemia (Abnormal Cholesterol), or Chronic Obstructive Pulmonary Disease (COPD).
    2020 Conditions: Chronic Heart Failure (CHF), Rheumatoid Arthritis, Diabetes, Dyslipidemia (Abnormal Cholesterol), or Asthma.
    • AND
  • Take eight or more chronic maintenance (Part D) prescription drugs in a 30-day period
    • AND
  • Likely to incur annual Part D Medication costs of at least $4,044 in 2019 and $4,255 in 2020

Once you qualify, you remain in the program for the rest of the calendar year. You will have to re-qualify for the next calendar year.

How We Notify You of Your MTM Eligibility

Once eligible, you will receive a letter that invites you to call Member Services to schedule your medication review. The review will last approximately 25 minutes, and we will schedule it at your convenience.

As part of your medication review, the pharmacist will:

  • Go over the medicine you are currently taking
  • Check to see if your medicine is safe for you
  • Answer questions you have about your medicine
  • Discuss lower-cost alternatives for your medicine
  • Discuss your concerns about your medicine
  • Work with you on ways to keep track of your medicine

You will receive a personal medication list and a summary of the medication review results (medication action plan). The medication list will help you keep track of the medications you take. The medication summary will offer you steps you can take to get the best results from your medications.

We include below a blank medication list you can print. Please use the form to keep track of all your prescriptions and over-the-counter (OTC) medications.

Printable Medication List

Printable Medication List – English(link opens in new window) 

Printable Medication List – Spanish(link opens in new window) 

Questions?

If you have questions, please call our Member Services number at 1-800-794-5907; TTY: 711. From October 1 - March 31, we are open 7 days a week; 8 a.m. to 8 p.m. From April 1 - September 30, we are open Monday - Friday, 8 a.m. to 8 p.m. You may always leave a voice mail message after-hours, Saturdays, Sundays, and holidays and we will return your call within 1 business day.